Example

Angelica’s Story

When Angelica was first hospitalized with schizophrenia at 17, she was covered by her mother’s employer-sponsored health coverage. But when Angelica turned 26, she couldn’t stay on her mother’s insurance anymore, even as her need for mental health support increased — she could no longer hold down a job, was running out of money and ideas, and had no health coverage.

Angelica’s aunt helped out by paying for Angelica’s trips to a psychologist, who helped her understand what was going on. “You have a medical condition, a mental health issue, which keeps you from working. The government calls that a disability," the psychologist said. "Why don’t you talk to Social Security and see if you qualify for disability benefits?"

Applying for Help

In December, Angelica made an appointment with her local Social Security office. At her appointment, she told her Social Security worker, Lauretta, about her medical history and her inability to work. She’d had no work for three months and was down to the last $500 in her bank account. She gave Lauretta documents she had brought that showed her situation, including bank statements, tax records, pay stubs, and contact information for all the doctors and hospitals she’d dealt with.

Lauretta said that based on her medical and work history, Angelica should be eligible for disability benefits, either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). First, Social Security would check their records to see if Angelica had worked enough in the past to qualify for SSDI; otherwise, she’d probably get SSI instead. “You haven’t been able to work at the Substantial Gainful Activity (SGA) level — $1,690 per month — for some time now," Lauretta explained. "And with just $500 in resources, you’re below SSI’s $2,000 resource limit . So you'll likely qualify."

Lauretta started filling out an application for Angelica, using the documents she had brought. "The application process could take several months," she told Angelica. "However, if you do qualify for SSI, we'll pay your SSI benefits all the way back to your application date, which is the date you called to make this appointment."

Angelica was nervous about having to wait for so long to start getting benefits. She was out of money right now. Lauretta suggested that she apply for some state programs that didn't require a disability determination, like Medicaid and the Supplemental Nutrition Assistance Program (SNAP), while she waited for SSI.

Waiting

Angelica went to her local Health and Human Services (HHS) office to see if she could get other benefits. The eligibility worker told her that she would probably qualify for Medicaid and SNAP, and he gave her both application forms to fill out.

Angelica was a little confused, because she knew that she would get Medicaid automatically once she got SSI—but she wasn't approved yet. "Are you sure I can get Medicaid without getting SSI?" she asked.

"Yes," the eligibility worker told her. "If your income is below 138% of the Federal Poverty Guidelines (FPG), you can get Medicaid through the Iowa Health and Wellness Plan (IHAWP) whether or not you have a disability."

This was a relief to Angelica, who didn't know that she could have been on Medicaid instead of being uninsured. A few weeks later, she got two different letters in the mail — she had been approved for Medicaid and for SNAP. She was breathing easier, now that she had health coverage and some money for food.

On February 22, Angelica got a letter from Social Security. At first she was upset, because it was a denial letter. However, she read the letterhead carefully. It turned out that Social Security Disability Insurance (SSDI) had denied Angelica because she didn’t have enough work credits to qualify. That's what Lauretta told her would probably happen. Social Security just had to check if she was eligible for SSDI first, before they could consider her for SSI.

She still had some more waiting to do.

Award

On April 12, Angelica got her SSI award letter. She qualified for $994 per month in SSI benefits. She called up Lauretta to ask what would happen next. Lauretta explained, “First, SSI will pay you retroactive benefits. Since you made your appointment back in December, SSI will give you benefits for each month you’ve been waiting since then.”

“When you’re feeling up to it,” Lauretta added, “you can start thinking about going back to work a few hours a week. You’ll have to report any changes in your income both to Social Security and to your local Health and Human Services (HHS) office. But it’s worth it, because your SSI benefits amount will go down by less than your earnings, so you should always end up better off if you can work. For example, if you were earning $300/month, your SSI benefits amount would only go down by $107.50."

"Try out DB101’s Benefits and Work Estimator to get a feel for how earnings and SSI work together. When you are seriously considering going back to work, you should contact a benefits planner for more help.”

“Thanks for everything,” said Angelica.